BILL ANALYSIS Ó
AB 1580
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Date of Hearing: March 27, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 1580 (Bonilla) - As Introduced: February 2, 2012
SUBJECT : Health care: eligibility: enrollment.
SUMMARY : Makes technical and clarifying changes to provisions
enacted in AB 1296 (Bonilla), Chapter 641, Statutes of 2011
relating to revised and simplified applications for state health
subsidy programs. Specifically, this bill :
1)Clarifies that a requirement granting an applicant benefits
during the time the application for eligibility is being
reviewed, also known as presumptive eligibility or PE, is not
intended to grant a right to PE beyond what is currently
required.
2)Clarifies that only when the applicant appears to be eligible
for Medi-Cal under the aged, blind, or disabled category, but
is determined to be ineligible after a screening for the new
Modified Adjusted Gross Income (MAGI) category, the
application will be forwarded to the Medi-Cal program for
further determination.
3)Makes other technical and clarifying changes.
EXISTING LAW :
1)Establishes the federal Medicaid Program, Medi-Cal in
California, administered by the Department of Health Care
Services (DHCS), to provide comprehensive health care services
and long-term care to pregnant women, children, and people who
are aged, blind, and disabled.
2)Establishes the Managed Risk Medical Insurance Board (MRMIB)
and authorizes it to administer the Healthy Families Program
(HFP), the Access for Infants & Mothers (AIM) Program, the
Major Risk Medical Insurance Program (MRMIP), and the
Pre-Existing Condition Insurance Plan (PCIP).
3)Requires, under federal law, each state, by January 1, 2014,
to establish an American Health Benefit Exchange that makes
qualified health plans available to qualified individuals and
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qualified employers.
4) Requires, under federal law, by January 2014, that states
offer Medicaid coverage to all adults, under age 65, with
income up to 133% of the federal Poverty Level (FPL) using a
MAGI calculation.
5)Requires, under federal law, by January 2014, that state
enrollment systems for persons eligible for health subsidy
programs utilize a single streamlined application for
specified public subsidy programs.
6)Provides that certain limited categories of eligible
individuals, such as pregnant women, are granted immediate,
temporary Medi-Cal coverage for limited benefits by qualified
providers.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the sponsor, Western
Center on Law and Poverty (WCLP), this bill is needed to
fulfill the terms of an agreement made with the prior Director
of DHCS, David Maxwell-Jolly to amend the language of AB 1296.
The agreement is memorialized in a letter dated September 21,
2011. According to the letter, WCLP agreed to pursue
amendments in the 2012 session to clarify two provisions.
Specifically, the Director had expressed concern that language
describing individuals who may be potentially eligible for
Medi-Cal "was too broad" and the sponsor agreed to limit it to
"those who may be eligible as aged, blind or disabled."
Secondly, the Director requested clarification that AB 1296
was not intended to grant presumptive eligibility to any new
categories.
2)BACKGROUND . The federal Affordable Care Act (ACA) requires a
seamless "no wrong door" application system so that wherever a
consumer applies he/she is enrolled into the program for which
he/she is eligible. In 2010, California initiated the process
to implement provisions of the ACA and offer new health care
options, by passing AB 1602 (John A. Pérez), Chapter 655,
Statutes of 2010 and SB 900 (Alquist), Chapter 659, Statutes
of 2010 creating the structure and basic duties of the
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California Health Benefit Exchange (Exchange). These bills
did not include the system required by the ACA for eligibility
determinations and enrollment of consumers in health subsidy
programs. AB 1296 was the vehicle to implement the Health
Care Eligibility, Enrollment, and Retention Act and
establishes a process for developing a streamlined and
simplified eligibility and enrollment system and ensures that
individuals will be able to apply for public health coverage
programs in person, by mail, online, fax, or by telephone. AB
1296 also establishes a stakeholder process to consult with
MRMIB and other stakeholders to develop and test a single,
accessible, standardized paper, electronic, and telephone
application.
Under the ACA and proposed federal guidelines, every applicant
will be screened for eligibility under the simplified MAGI
standard without regard to the amount of assets the family or
individual owns. Individuals who do not meet the MAGI income
eligibility criteria will be further screened for eligibility
under the Medi-Cal aged, blind, or disabled category or for a
premium subsidy to purchase insurance through the Exchange.
3)SUPPORT . The American Federation of State, County and
Municipal Employees, AFL-CIO writes in support that this bill
makes technical changes to AB 1296 which implemented the ACA
requirement that states have a seamless "no wrong door" system
for determining eligibility for and enrolling people into
Medi-Cal, Healthy Families, and the Exchange.
4)RELATED AND PREVIOUS LEGISLATION .
a) AB 714 (Atkins) of 2011 would have required a
notification to individuals who have ceased to be enrolled
in specified public health care coverage programs and to
individuals receiving services under specified health
programs regarding potential eligibility for health care
coverage through the Exchange. AB 714 was held in the
Senate Appropriations Committee.
b) AB 792 (Bonilla) of 2011 would have required the
disclosure of information on health care coverage through
the Exchange, under specified circumstances, by health care
service plans, health insurers, employers, employee
associations, the Employment Development Department, upon
an initial claim for disability benefits, or by the court,
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upon the filing of a petition for dissolution of marriage,
nullity of marriage, legal separation, or adoption. AB 792
was held in the Senate Appropriations Committee.
c) AB 43 (Monning) of 2011 expands Medi-Cal coverage to
persons with income that does not exceed 133% FPL,
effective January 1, 2014. AB 43 is pending in the Senate
Health Committee.
d) AB 1595 (Jones) of 2010 would have required DHCS to
expand Medi-Cal eligibility to individuals with family
income up to 133% of FPL without regard to family status by
January 1, 2014. AB 1595 died on suspense in the Assembly
Appropriations Committee.
e) AB 1602 establishes the Exchange as an independent
public entity to purchase health insurance on behalf of
Californians, including those with incomes of between 100%
and 400% FPL, and employees of small businesses. Clarifies
the powers and duties of the board governing the Exchange
relative to the administration of the Exchange, determining
eligibility and enrollment in the Exchange, and arranging
for coverage under qualified carriers
f) SB 900 establishes the Exchange. Requires the Exchange
to be governed by a five-member board, as specified.
REGISTERED SUPPORT / OPPOSITION :
Support
Western Center on Law and Poverty (sponsor)
American Federation of State, County and Municipal Employees,
AFL-CIO
Health Access California
National Health Law Program
Opposition
None on file.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
AB 1580
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